The bitter pill

May 2, 2013

I meant to post this last week but time got away from me, it seems. Funny thing, I received this “threatening” collections letter the day I had my last Remicade treatment – which is also the day I read a really fascinating Time magazine article titled, “Bitter Pill: Why Medical Bills are Killing Us” by Steven Brill. It’s from Time’s March 4, 2013 issue and I luckily found a copy at the clinic so I snatched it up to read while being hooked up to my Remicade I.V. for three hours. Good decision! Although after reading the article (and in the middle of reading it), I became so infuriated and upset, because much of what Brill writes about has affected my life in similar ways. Unfortunately you have to pay to read the article online, but it’s really worth it. Everyone should read it – especially if you go to the doctor often, have a lot of medical expenses, or have any kind of health condition.

The article profiles several different patients and tells their stories about how they racked up huge medical bills, mostly from hospital expenses. Whether a cancer patient, an ER patient for heartburn thought to be a heart attack (and a $21,000 bill for that), the recipient of an overpriced implanted medical device, or a patient injured from a simple fall, one thing is constant in all of these stories – everyone was drowning in thousands, even hundreds of thousands of dollars of medical bills. And the majority of the medical costs of these bills were grossly inflated and overpriced. Luckily I have managed to stay out of the hospital so far this year, but since January 1 I have accumulated a lot of medical debt due to doctor office visits, MRI and X-ray scans, prescription drugs, and expensive I.V. treatments for my RA. Let’s also add the bills for my psychologist appointments that I find necessary to help me stay sane trying to navigate all of this health crap on a daily basis. I feel like I’m going to the doctor all the time, even when I sometimes do cancel appointments (especially the therapy appointments) just to save money. Or I try to hold off on making appointments until after I’ve met my deductible and out-of-pocket maximum for the year. I’ve heard stories from many other people who also go without their medications, treatments, or doctor visits because they can’t afford it. This, I feel, is simply wrong. Nobody should have to sacrifice his or her health because of financial reasons. But the way our healthcare system is set up, that is exactly what patients are pressured to do if they can’t afford their medical bills. Go into massive debt? Declare bankruptcy? Lose your house? Risk your life? It’s such a racket, with your dollars lining the pockets of the CEOs and administrators of many health care and hospital systems – especially these so-called “nonprofit” hospitals that are actually making huge profits.

Me, Remicade I.V. treatment, Maple Grove, MN, 2013

In the article, Brill says, “When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?” (Brill, Steven. “Bitter Pill: Why Medical Bills Are Killing Us.” Time. 4 March 2013: 18-55. Print.)

Yeah, good question. Why ARE they so high? Patients in other Western countries (France, Germany, England, etc.) pay only a fraction of what we do in the United States. Do we receive better care? No, on the contrary oftentimes. And why isn’t anybody raising a stink about this? About how Americans have been getting fleeced by the health care industry for decades? People’s lives have been ruined by it and it’s only getting worse. “Obamacare” (aka The Affordable Care Act) will help with some things but it can’t fix the entire system.

Brill states,

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country–from Stamford, Conn., to Marlton, N.J., to Oklahoma City –the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million (p. 20).

We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%, more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capital income in the U.S. vs. those other countries. Of the total $2.8 trillion spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance. This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses (p.21-22).

THE CHARGEMASTER:

What’s a chargemaster? I had never heard of it until reading this article. And, the chargemaster plays a big part in the article and in health care, yet most people have no idea it exists or what it even is. The chargemaster is every hospital’s internal price list. Brill says, “I quickly found that although every hospital has a chargemaster…Whenever I asked, they [hospital officials] deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.“

The most inflated charges on the chargemaster are billed to those without insurance, while patients with most forms of insurance (although some discount insurance policies aren’t even accepted at various hospitals) get a discount on the chargemaster prices. Although – insurance discount or not, the prices are hugely inflated. Example? Brill writes about a $108 charge for common antibiotic ointment that appeared on a patient’s bill under the category “Pharmacy General Classification.” For $5.14 I can get a tube of over-the-counter Bacitracin ointment from Target. I just called the pharmacy there and that’s the price I was quoted. $108 is a big difference compared to $5.14. That’s just one small example of common hospital supplies whose prices are ridiculously inflated in clinic and hospital use. Another example Brill writes about is patients getting charged for the surgeon’s hospital gown (the hospital charges X amount when you can get the same gown on Ebay for a fraction of the cost), a “warming blanket” that is probably going to be reused, the black Sharpie marker used to mark the incision spot on a patient’s body before surgery (this one blew my mind), diabetes test trips (hugely inflated price), basic little gauze pads (available online for a fraction of the hospital price), generic Tylenol for $1.50 a pill (how many pills in a bottle can you get at CVS or Target? Do the math), and so on. All of these extra charges add up quickly, never mind the big charges–such as hospitals making money on what they charge patients for routine lab work and tests, MRI scans, and the cost of medical devices (from such companies as Minnesota’s very own Medtronic).

To put things simply (hopefully I’m not simplifying too much) – one of the most immoral, unethical deceptions that I see is the use of this “chargemaster” by the hospitals–that they can basically charge and make patients pay whatever they want and there is no regulating this process. A lot of people whine and moan about Medicare sapping our federal resources and sucking the money out of taxpayers’ wallets, but Medicare costs are actually controlled and regulated by Congress. There are checks and balances going on with how health care prices are determined, and therefore they are kept at manageable, affordable rates. Yes, but that means hospitals are losing money to Medicare patients, right? No.

“When hospitals say they are losing money on Medicare, my reaction is that Central Florida is overflowing with Medicare patients and all those hospitals are expanding and advertising for Medicare patients,” says Jonathan Blum, deputy administrator of the Centers for Medicare and Medicaid Services. “Hospitals don’t lose money when they serve Medicare patients” (p.47).

To wrap up – this article is excellent and informative and gives a straightforward look at what’s going on in the health care industry today regarding patient costs and medical debt. It’s a really long article, but worth the read. Brill tells heartbreaking stories of people falling into financial ruin due to medical bills, and touches on topics such as Medicare, Medicaid, “Obamacare,” health insurance, cancer care, drug companies, collection practices, national and international health care cost statistics, and a lot more. Please read the article and tell me what you think. Living for the last 15 years with a chronic, expensive disease has not only sapped away some of my happiness and freedom but also a lot of my money–which has also taken away my freedom and happiness. I know I’m not alone in this sinking boat, either. This affects everyone, whether you’re sick or not. All it takes is one injury or accident or health problem to land you in thousands of dollars of debt.

Hi Jono,
Thanks for your comment. I agree – I think the majority of patients have no idea what’s going on with billing practices. “Fair” is a key word here. What’s going on with the inconsistencies, the lack of transparency, and the lack of honest communication between providers and patients is definitely not fair nor ethical, in my opinion.

When you get that very first bill, match it up with the corresponding EOB (Explanation of Benefits). Look over each and see if there are any overcharges. If everything is correct, then call either the hospital or doctor’s billing department and ask to set up a payment plan. This way, you are officially on the books as making payments. If you need help reviewing large medical bills, HooPayz can help with that, too. http://www.hoopayz.com